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RC Peds Endo 2023 > Obesity > Flashcards

Obesity Flashcards

1
Q

Definition of obesity

A

> 2yo:
Overweight: BMI 85th - <95th %ile for age and sex
Obese: BMI >95th %ile
Extremely obese: >120% of the 95th percentile or >35 kg/m2

<2yo:
Obese: Sex-specific weight for recumbent length is >/=97.7th %ile on the WHO charts

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2
Q

Endocrine causes of obesity

What is an important clinical sign

A

GH deficiency,
hypothyroidism, or
Cushing syndrome

stature and height velocity are decreased
weight maintained

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3
Q

Comorbidities of Obesity/Overweight

A

Prediabetes/T2DM

Dyslipidemia

Sleep apnea

Cardiac:
- Prehypertension/hypertension
- Early subclinical atherosclerosis
- Cardiovascular disease (CVD)

GI:
- Esophagus: GERD, Barrett’s esophagus, esophageal cancer
- Gastric: hiatal hernia
- Hepatobiliary: NAFLD, gallstones, pancreatitis
- Colon: diarrhea, constipation, colonic adenomas and colorectal cancer

Renal:
- Proteinuria
- Focal segmental glomerulosclerosis

Hyperandrogenemia/PCOS

Slipped capital femoral epiphysis and pseudotumor cerebri

Depression
Social isolation
Poor quality of life

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4
Q

who should have genetic testing for obesity

A
  • extreme early onset obesity (before 5 years of age)
  • clinical features of genetic obesity syndromes (in particular extreme hyperphagia)
  • family history of extreme obesity
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5
Q

What are genetic obesity syndrome with developmental delay?

A

Prader Willi syndrome
AHO
SIM1 deficiency
BDNF/TrkB deficiency

Bardet Biedl syndrome
TUB deficiency

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6
Q

What are genetic obesity syndrome without developmental delay?

A

Alstrom syndrome
MC4R deficiency (melanocortin 4 receptor)
SH2B1 deficiency
KSR2 deficiency

Leptin deficiency
Leptin receptor deficiency
POMC deficiency
PCSK1 deficiency

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7
Q

Prader willi - inheritance

A

dominant

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8
Q

genetics of PWS

A

A methylation disorder caused by the deletion of a critical segment on the paternally inherited chromosome 15q11.2-q12, loss of the entire paternal chromosome 15 with the presence of 2 maternal copies (uniparental maternal disomy), or an imprinting defect that can be sporadic or due to a mutation of the paternally derived imprinting control site of the 15q13 region

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9
Q

genes in monogenic obesity

A

LEP: Leptin gene mutation
LEPR: Leptin receptor gene mutation
POMC
MC4R
PCSK-1
NTFK2
SIM1
BDNF (BIG DADDY NEEDS FOOD)

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10
Q

hormones or proteins that stimulate appetite

A

● Agouti-related peptide (AGRP)
● NPY
● Ghrelin

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11
Q

hormones that suppress appetite

A

● Leptin
● Polypeptide Y (PPY)
● CCK
● GLP-1
● POMC
● PP (pancreatic polypeptide)
● Insulin

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12
Q

types of bariatric surgery

A
  1. Roux-en-Y Gastric Bypass - most effective
  2. Laparoscopic Sleeve Gastrectomy - most common
  3. Laparoscopic Adjustable Gastric Banding (LAGB) - not used
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13
Q

chronic complications of bariatric surgery

A

● Dumping syndrome
● Hypoglycemia
● Malnutrition
● Vitamin Deficiencies
● Anemia
● GERD
● Bowel obstruction
● Hernia

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14
Q

features of metabolic syndrome

A

○ hypercholesterolemia
○ T2DM
○ Brain - Pseudo-tumor cerebri
○ Lungs - OSA
○ Heart - Hypertension
○ Kidney - Microalbuminuria
○ Liver/GI - NAFLD, gallstones, pancreatitis
○ Ovaries - PCOS, Infertility
○ MSK - Joint pain/osteoarthritis and Blount’s
○ Psych - Increased mental health disorders
○ Extremities - Gout & hyperuricemia

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15
Q

what meds are approved for weight loss in children

A

orlistat
- reducing fat absorption and can decrease BMI

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16
Q

anorexogenic pathway
- effect on appetite
- stimulus wrt food
- neuron
- hormones

A

suppresses

intake

POMC

leptin, insulin
aMSH

Other:
CCK
Peptide YY
Panc PP
GLP1

17
Q

orexogenic pathway
- effect on appetite
- stimulus wrt food
- neuron
- hormones

A

stimulates

fasting

NPY-AgRP

Ghrelin
AgRP, NPY

18
Q

Factors that Increase Leptin:

A

○ Increased body weight / weight gain
○ Eating
○ Insulin
○ Glucose
○ Glucocorticoids
○ EtOH

19
Q

Factors that Decrease Leptin:

A

○ Fasting
○ Weight loss
○ Beta adrenergic stimulation
○ Androgens
○ GH
○ Smoking
○ Insulin resistance

20
Q

WHO def of metabolic syndrome

A

glucose intolerance or insulin resistance and ≥2:
- Elevated TG
- Low HDL-C
- High BMI or waist-hip ratio
- HTN
- Microalbuminuria

21
Q

Improvements wit bariatric surgery

A

Reduced:
- BMI
- Type 2 DM
- htn
- dyslipidemia
- CVD risk factors

22
Q

Criteria for Bariatric surgery

A
  • BMI greater than or equal to 40
  • BMI greater than or equal to 35 but less than 40 + at least one of the following comorbidities:
    Coronary heart disease
    Type II Diabetes mellitus
    Hypertension
    Diagnosed sleep apnea
    Gastroesophageal Reflux Disease (GERD)

other criteria:
- Completion of puberty (tanner IV) (not mentioned in AAP 2022 Guidelines)
- Able to provide informed consent
- Family support with realistic expectations of bariatric surgery
- Regular attendance in a medical obesity program and evidence of positive lifestyle changes
- Mental health stability

23
Q

C/I to bariatric surgery

A
  • Medically correctable cause of obesity
  • Untreated or poorly controlled substance abuse (within the past 12m)
  • Concurrent or planned pregnancy (within the next 18mo)
  • Current eating disorder
  • Inability to adhere to postoperative recommendations and mandatory lifestyle changes
  • SickKids says must be Tanner 4

(no age)

Other’s mentioned elsewhere:
- Anesthesia/surgical risk

  • Structural GI abnormality
  • Developmental Delay
  • Smoking within 6 months of surgery
  • Recent major cancer (life threatening, within last 2 years)
24
Q

Short term complications of bariatric surgery

A
  • nausea
  • dehydration
  • pain
  • bleeding
  • leak
  • infection
  • reoperation need
25
Q

Long term complications of bariatric surgery

A

NUTRITIONAL (fat sol, anemia, bones)
- ADEK vit def
- iron def
- B12 def
- folate def
- Ca def
- Vit D def

METABOLIC
- hypoglycemia
- metabolic acidosis or alkalosis
- low lytes: Ca, phos, Mg, K, Na

GI
- dumping syndrome
- cholelithiasis
- GERD
- Nausea, bloating, diarrhea
- short bowel syndrome
- abdo operation comp: adhesions, gastrostomy, hernia, obstruction

26
Q

Sx Dumping syndrome

A

hypoglycemia
colicy abdo pain
diarrhea
nausea
tachycardia

dizziness
fatigue
diaphoresis
weakness
tremor
drowsiness
palpitations

RC Peds Endo 2023 (17 decks)

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